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NPI Code Detail

MEDICARE: PEDPOST FOUNDATION INC

MEDICARE: PEDPOST FOUNDATION INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QH0100XHealth Service Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
177128OTHERGASTATE LICENSE

General Provider Information

NPI Number : 1821592593
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEDPOST FOUNDATION INC
Provider Business Mailing Address
First Line : 12600 DEERFIELD PKWY STE 100
Second Line :
City : ALPHARETTA
State : GA
Zip : 30004-6130
Country : US
Telephone Number : 470-222-0375
Fax Number :
Provider Business Practice Location Address
First Line : 12600 DEERFIELD PKWY STE 100
Second Line :
City : ALPHARETTA
State : GA
Zip : 30004-6130
Country : US
Telephone Number : 470-222-0375
Fax Number :
Authorized Official
Title or Position : MD
Name : ESEOVHE EGBORGE
Credential :
Telephone Number : 470-222-0375
Provider Enumeration Date : 03/19/2018
Last Update Date : 06/09/2023

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Directions to “PEDPOST FOUNDATION INC ” Practice Location

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